chaperon-enrollment-france

University Partner Representative
Enrollment

Program in Person in Europe (Paris & Amsterdam)

STEP 1 - Please fill out the enrollment form below & click on "Go to Step 2".
STEP 2 - Please read and sign 2 documents : (a) Rules & Regulations (b) Program Agreement.
Thank You !

Program

Program/School Name *

Program Year *

Program Location *

General Information

First Name (Prénom) *
Last Name (Nom de famille) *

Email *

Please use the email address on which you received our emails. This email address will be used by our system to make sure your enrollment process goes well. Please always use this email address for everything related to your stay in Chicago. If you want to use another email address, please send us an email: studentservices@seagullinstitute.com

Birthday *

Please enter your birthday as MM-DD-YYYY

Country of citizenship *

If "Other" please specify.

Street Address 1 *
Street Address 2
City *
Postal Code *
Country (of residence) *

Cell Phone *

WhatsApp number *

Emergency Contact & Health Information

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Email *

Emergency Contact Home Phone *

Emergency Contact Cell Phone *

Do you have any health conditions that we should be aware of in case of emergency? *

Do you have any food restrictions? *

Travel Information (flight/train)

Dates should be as follow: MM-DD-YYYY

Arrival in Paris/Amsterdam (date et heure d'arrivée en début de séjour) *

Departure from Paris/Amsterdam (please enter date and time as it appears on your ticket - Date et heure de départ en fin de séjour) *

Arrival Flight/Train number and Airline/Train Company (Example: "United Airlines UA 987") *

Others

Have you previously been convicted of a felony or a other crime that has resulted in legal action? (Either in the US or in France) *

YesNo

It is very important that you receive our emails and communication. To make sure you do, you can add us as a "safe sender". Please take a minute to set up your email account and make sure you will not miss any important communication.

Add the following address as "safe sender": studentservices @seagullinstitute.com
Visit this link for help on how to set up your email account/client

Now that you have set up your email account to receive our email you may submit your form.

By clicking on the "GO TO STEP 2" button below you agree that your submission of this form constitute the execution of this document in exactly the same manner as if you had signed by hand a paper version of this agreement.

If nothing happens when you click on the "GO TO STEP 2" button, go back to the top of the page and make sure you have answered all required fields.

University Partner Representative​Enrollment​Program in Person in Europe (Paris & Amsterdam)​STEP 1 - Please fill out the enrollment form below & click on "Go to Step 2".STEP 2 - Please read and sign 2 documents : (a) Rules & Regulations (b) Program Agreement.Thank You !

University Partner Representative
Enrollment

Program in Person in Europe (Paris & Amsterdam)

STEP 1 - Please fill out the enrollment form below & click on "Go to Step 2".
STEP 2 - Please read and sign 2 documents : (a) Rules & Regulations (b) Program Agreement.
Thank You !